Two thirds of local authorities face shortfall in public health budgets despite increased funding

BMJ 2013; 346 doi: (Published 11 January 2013) Cite this as: BMJ 2013;346:f234
  1. Caroline White
  1. 1London

Around two thirds of local authorities in England will find themselves short of the money needed to meet their target spending per head on public health by the end of 2014-15, show figures on the two year settlements allocated to them by the Department of Health.1

This is despite real term increases of up to 10% on the budgets for both 2013-14 and 2014-15 proposed by the outgoing primary care trusts, which relinquish responsibility for public health this April.

The overall budget for public health services managed by England’s 152 local authorities will be £2.7bn (€3.3bn; $4.4bn) in 2013-14 and just under £2.8bn in 2014-15. The health secretary, Jeremy Hunt, announced on 10 January that the money would be ringfenced.

Local authorities will not assume responsibility for immunisation and vaccination, health protection and surveillance, local infectious disease outbreaks, or emergency planning. But their remit will include five statutory services, including sexual health and the national child measurement programme.

The settlements for individual local authorities, however, show wide variation in spend per person. Altogether 99 authorities will fall short of their targets by 2014-15, by less than 1% in the London borough of Hillingdon, for example, to as much as 43% in its immediate neighbour to the west, Slough, in Berkshire.

The targets were worked out by the independent Advisory Committee on Resource Allocation, which used a new formula that was based on premature death rates among the under 75s and was weighted towards those areas with the poorest public health outcomes. But it has produced some apparent anomalies.

Wealthy boroughs, such as Richmond upon Thames, in London, which has a target of £33 to £34 per head over the next two years, has been allocated £40 per head for each year, while deprived boroughs, such as Waltham Forest in northeast London, with a targeted spend of £67-£68 per head, has been allocated £42 in the first year and £45 in the second.

“The figures are based on historical [primary care trust] spend, and it’s about moving that to the formula developed by ACRA [the Advisory Committee on Resource Allocation],” Nicola Close, chief executive of the Association of Directors of Public Health, told the BMJ. “It will take several years before spending reaches the target based on the formula.”

But the allocations were “good news, overall,” she said. The legacy of high spending primary care trusts had to be passed on to the relevant local authorities to avoid services—some of which would be used by residents of neighbouring boroughs—from being cut overnight, she added.

“The bottom line is that those boroughs [with a shortfall over both consecutive years] won’t be able to meet their targets,” Close acknowledged. “We would have liked everyone to have had the money they needed to meet the target straightaway, but that would have meant a significant increase in the quantum of around £1.2bn more.”

She added, “There’s only one health budget, so the more that is pushed towards public health, the more that has to come out of the zero sum budget [the total NHS budget] from the Treasury.”

Concerns have been voiced that cash strapped councils might interpret public health loosely so as to maintain other services. But a health department spokeswoman said that they would need to prove they had used the money to improve the health of the local population.

“The kind of services we would expect to see would include smoking cessation, drug and alcohol misuse services, and sexual health services,” she said.

A spokesman for the Local Government Association, which represents local authority interests, told the BMJ that the two year settlement gave councils some stability and that the health department had promised to revisit clear cut cases of shortfalls.

“We are confident that councils have enough money to cover their statutory services, but whether they will have enough for an all singing, all dancing public health service isn’t yet clear,” he said.


Cite this as: BMJ 2013;346:f234